I move: "That the Dáil do now adjourn."
Adjournment Under Standing Order 30. - Non-Consultant Doctors' Dispute: Motion.
The Deputy has 20 minutes, the Minister for Health has 20 minutes and other speakers have 15 minutes.
I thank the Ceann Comhairle for the opportunity to raise this issue in the Dáil today under Standing Order No. 30. I understand from precedents this is quite a rare occurrence. It is indicative of the urgency with which the House views the doctors' dispute that it has been possible to achieve this debate here today. The issues at the heart of this dispute concern basic trade union principles. The fact that those who are taking industrial action wear white coats and have professional qualifications does not alter that fact one bit. The non-consultant hospital doctors are employees who are in receipt of salaries and pay tax, PRSI, health contributions and so on, in just the same way as any other employees, and they have a right to be treated fairly in the same way as any other employees.
The basic issues in this dispute involve the principles that employers should be expected to honour agreements entered into, and that employees should not be expected to accept a unilateral decision to worsen their working conditions. In February 1986 the Irish Medical Organisation on behalf of the non-consultant hospital doctors and the local government staff negotiating board, on behalf of the employers, signed a new agreement. The Irish Medical Organisation has made it quite clear that they will instruct their members to return to normal working forthwith if the Minister for Health instructs the hospital managements to adhere to the terms of the 1986 agreement. This is a reasonable proposal and I find it shocking that the Minister should be prepared to risk the health and possibly the lives of patients, by refusing to do so.
The 1986 agreement represented an important advance for the junior hospital doctors. Perhaps junior is a misrepresentation because in many cases these doctors have ten years experience, are in their mid-thirties and have families to support. It was an important agreement in that it recognised for the first time that they should not have to work more than 80 hours per week. Even with the implementation of the 1986 agreement the doctors were still working an average of 70 hours a week. They now quite rightly fear that if redundancies go ahead at the level which has been demanded they will again be in the situation where they will have to work 80 hours or more per week.
This raises two important issues. First, as we approach the end of the 20th century it is surely quite unreasonable that any employee should be asked to accept a working week that is about twice the length of the average working week for other workers. There is also the question of patient welfare. Hospital doctors work under great pressure. They must often make rapid decisions — decisions on which the welfare and often the life of a patient will hinge. It is surely not in the patients' interest that doctors should be asked to make decisions like this, when they have been on their feet for 12 or 14 hours, or even longer. No matter how well trained a doctor is, no matter how conscientious a doctor is, there is always a danger that someone who is asked to work such long hours will simply make an error of judgment through sheer exhaustion.
This dispute must also be seen against the background of the savage programme of cutbacks and the inpatient and out-patient charges which have been introduced since the return to office of the Fianna Fáil administration. These have led to considerable distress and inconvenience among patients and those awaiting treatment, and have been met with unprecedented opposition from staff within the health service. The reaction of health staff at all levels has been so strong because they realise what many of the public have not yet recognised, that what we are now witnessing is not simply a series of cutbacks, but a systematic butchering of the public health system. It must be clear that if this madness is allowed to continue, the entire public health service, which has been painstakingly built up over the years, will be dismantled within a short space of time.
Despite the assurances given by the Minister for Health and his colleagues in Government, there is no doubt that the standard of patient care has fallen as a result of these cuts. I am sure that many people were shocked by the sight of Dr. Matthews, head of the neo-natal intensive care unit of the Rotunda Hospital, saying on the television news last night that because of reduced funding from the Department of Health they did not have enough nurses and that they had to hope that two or three babies did not fall ill at the same time. He said: "We live on a knife edge and we keep our fingers crossed that two or three babies don't get sick at the same time". I think it is appalling that these health cuts have led to a situation where the health and welfare of babies should have to depend on chance. Despite assurances that the hospital outpatient and inpatient charges would be implemented in a humane way. I have had complaints from constituents whose children were refused treatment in the casualty and outpatient departments of Temple Street Hospital simply because they did not have the money with them to pay the £10 charge. In the last two days a two year old child was brought to that hospital as a result of an accident in which he hurt his foot. The child was refused care until such time as an assurance was given that the £10 would be paid. On the following morning a nine year old child was refused outpatient care. He had returned to the hospital with an arm injury which had been treated some time ago but was refused treatment because the adults with that child did not have £10 with them.
The Minister of course says that the decisions on the cutbacks are being made by the health boards and not by him: that he has simply decided on the level of money that can be allocated to each board. But the Minister cannot be allowed to wash his hands like Pontius Pilate and absolve himself from responsibility for the savage cuts which are now taking place. He has reduced funding to such an extent and in such an arbitrary fashion that the health boards and the hospitals have been left in an impossible position. Neither the Minister nor the Government can escape responsibility for this dispute, which is a direct consequence of decisions taken by them, and they cannot escape their responsibility to seek a nationally negotiated solution to the dispute. It is quite unacceptable that the Minister should refuse to negotiate with the IMO and try to force them into a series of local negotiations with particular hospitals. There is an obligation on the Minister to ensure that all hospitals, financed from public sources, have a common and uniform personnel policy. The Minister has an obligation also to ensure that there is a common high level of patient care available at hospitals all over the country, and to achieve this it is necessary to insist that there will be a common level of working conditions for doctors, nurses and other essential health personnel.
A common high level of patient care cannot be guaranteed if there is one level of staffing at one hospital and a different level in another, and if doctors in one area are expected to work 50 hours per week while those in another are expected to work 80 per week. There are already considerable regional disparities in the standard of care available to patients. Local negotiations will simply widen the regional disparities that already exist. Again I quote an example of a man I met in the corridor today. He told me he has to bring his child 200 miles from Ballina to St. Michael's Central Remedial Clinic, Dublin. Clearly this is intolerable.
It is significant that the Minister has chosen to take on the non-consultant hospital doctors, who already endure very harsh working conditions and an unexceptional level of remuneration, but has done nothing about the pampered privileged position of the consultants. Of course, the whole strategy of the Government in relation to the health cuts has been that the weakest should be expected to carry the heaviest burden. Ordinary people who have already paid their health contributions and PRSI are now expected to pay for out-patient and in-patient services, while millions of pounds of taxpayers' money is used to subsidise the super-elite treatment for the privileged few in luxury hospitals that charge up to £1,200 per week. Junior doctors, nurses, cleaners and other workers are asked to accept job losses and poorer conditions, while the drug companies are allowed to profiteer at the expense of the taxpayer and the health service.
The IMO have already pointed out that expenditure on drugs is one area where significant savings could be made without jeopardising the standard of care for patients. Dr. Brendan Cuddihy of the IMO Non-Consultant Hospital Doctors Committee was quoted in The Irish Times of 4 June as saying he saw no reason why the annual £60 million cost of drugs for the general medical service could not be trimmed by 20 per cent, as had been done two years ago in the UK without harming patients or restricting doctors' scope for prescribing adequate medicines.
He pointed out that money was being spent on drugs which were in some cases useless, and claimed that private importers were importing drugs at up to 40 per cent less than the price charged for the drugs here, but the benefit was not being passed on to the consumer. He suggested that the Department of Health should be involved in paralleled importing of drugs in a big way. Of course there is little prospect of the Government doing this, as to do so would be interfering with what they regard as the absolute right to make profit. It is quite clear that Fianna Fáil attach far more importance to the private profit ethic than to the ethic of a public health service.
The proposals put originally to the doctors would have resulted in a loss of about 200 jobs among the non-consultant hospital doctors. The doctors have said they are prepared to accept some level of job losses, but not 200. I think, however, that putting doctors out of jobs is a false economy. Those who lose their jobs are not likely to go into private practice, and many of them will have no alternative but to emigrate, and their services and expertise will be lost to the country. The money spent on their training will have been wasted so far as the Irish people are concerned..
The non-consultant hospital doctors are clearly resolute in their determination to fight their case. Anyone who has any doubt about that should look at the results of their secret ballot yesterday, when they voted by 686 to 22 — a majority of 96 per cent — for a total withdrawal of services from all hospitals on Saturday. The IMO have made it quite clear that they do not want to jeopardise patients' welfare and will provide cover to assist consultants in emergency cases. While I accept the IMO bona fides in giving this undertaking, I fear that the inevitable disruption and chaos that will follow from their action will end in tragedy.
In an interview in The Irish Press of 25 September 1984, the present Taoiseach, Deputy Charles Haughey said: “The health services have been reduced to dangerously inadequate levels, and I think that if it hasn't happened already, people will die because of the unavailability of particular services in certain areas”. That statement was made by the Leader of the Fianna Fáil Party in Opposition. Is it going to take the deaths of patients to force Fianna Fáil from an even worse situation than existed a year ago, and from the disastrous course on which they have embarked?
If a disastrous escalation of the doctors' dispute is to be avoided, the Minister must ensure that the 1986 agreement between the non-consultant hospital doctors and their employees is honoured, and he must open negotiations at a national level with the IMO.
I understand that today tentative talks took place between the Local Government Staff Negotiations Board and the IMO — talks about talks. Perhaps the Minister could tell us if any progress was made and if there is a possibility that he will meet the IMO to try to resolve this dispute before the weekend. In the wider context he must halt this disastrous programme of health cuts and chaos which they are creating and enter into negotiations with all the parties involved to work out a planned and coherent development of the health services which will provide the highest quality of patient care in the most economic way. It is not possible to do that under present conditions where, in 1987, the Minister has indicated arbitrarily the amount of money available and, in effect, is forcing severe cutbacks in the services available for people who need care. The Minister and the Government must back off from the disastrous course they are on at the moment and seek to settle this dispute between the non-consultant doctors and their employers. He should sit down with all the interested parties and thrash out the future development of those services.
Is the Minister offering now or later?
I am calling Deputy Bernard Allen.
I am caught unawares because I thought the Minister was offering and that we were keeping to the order you read out.
There is no such order.
I am making this contribution tonight because our hospitals are in crisis. People's lives are threatened. Babies are lying in some of our hospitals and old people are worrying if they will be alive next week because of the cutbacks in our health services.
Does the Deputy propose to share his time?
Yes. I propose to give some of my time to the deputy spokes-person——
Is that agreed? Agreed.
The Minister has brought the health services into a deep crisis. Last night I got a phone call from a distraught mother whose child lies awaiting surgery in the surgical ward of a local hospital. She wants to know if her child should suffer more, or possibly die next week, for want of surgery. I ask the Minister to call on the President of the Irish Medical Organisation to come into the Department and open negotiations on the problems that exist. The Minister should attempt to sort out these problems before something serious happens.
The poorly paid, overworked junior hospital doctors have contracts agreed at local level. These contracts are negotiated with such bodies as the Local Government Staff Negotiations Board and the Minister now wants to hand the negotiating process back to the local health boards and hospital boards. I put it to the Minister that he is opting out of his statutory responsibility. He is seeking to avoid reality in his bunker in the Custom House, protected by men who do not leave their offices, who do not know about the pressures and the everyday life in hospitals, who do not have to work in casualty departments, in surgical units, in theatres, in coronary care units or assist the dying in their last moments. The Minister has chosen the protection of the faceless people who have perpetrated a deep and grave crisis on the people of the country. Is it too late to make an appeal to his better sense, to appeal to his compassion and ask him, in the interests of the people of the country, to desist from the policy path he has chosen and move instead to the pragmatic path of reality?
I challenge the Minister on leaving the House to contact the president and secretary-general of the IMO and ask them to attend a meeting with him in an attempt to resolve the outstanding matters that have caused this serious strike. I suggest to him that he should spend the weekend working until such time as the negotiations have successfully resolved the matters at issue. I appeal to him to do everything in his power to resolve this catastrophic strike which may escalate on Saturday.
I should like to address an appeal to the president of the IMO and the junior hospital doctors. If following this debate tonight the Minister agrees to meet the people involved in an effort to resolve these outstanding issues will they withdraw their strike action threatened for next Saturday? On compassionate and caring grounds I ask them to return to work and continue to provide the very necessary care for all those in our hospitals and those awaiting admission. It is important that I should try to extract from the Minister a commitment to negotiate with the doctors and that they should decide to call off the strike if the negotiations take place.
On a number of occasions the Minister said that the negotiations are being left to the health boards and the hospitals concerned but I put it to him that responsibility and accountability for health care rests with him. The disjointed, ad hoc way in which he has caused the crisis leads me to believe that the Taoiseach, who is present, should arrange to have him replaced. The Taoiseach should consider inviting the Minister for Labour, or the chairman of the Employer-Labour Conference, to bring about an end to this strike. I appeal to the Taoiseach to intervene to arrange such a conference, even at this late hour.
Deputy De Rossa gave details of the contracts the junior hospital doctors had signed and of the agreement reached in 1986. There is no doubt that the terms of the agreement have been torn to tatters and discarded. Deputy De Rossa pointed out that the local government staff negotiating board today attempted to bring the parties together in an effort to solve the problems. I gather that those efforts were not successful but I hope further efforts will be made and that the Minister will get directly involved.
We are all aware of the issues in the dispute but the Minister has set out to misrepresent some of them. I have met representatives of the junior hospital doctors and I am aware that they are not asking for special treatment. They recognise the need for rationalisation of our health services but they insist that the 1986 agreement be adhered to. They insist that there must be a limit on working hours. At present it is economically attractive for the Department, and the health boards, to insist on a reduction in the number of junior doctors because they can put the remainder on overtime. They will only get one-third of the amount of overtime. If they are put on a one-in-two rota they will be working a five-day week, from 9 a.m. to 5 p.m.; every second night and every second weekend. For example, if they are working at weekends they will have to work Saturday, Saturday night, Sunday and Sunday night and all day Monday. In between they may get a few hours sleep. Can the Minister say that those doctors can give a comprehensive service to the public? Surely the Minister will agree that the lives of patients are at risk under such an arrangement.
I should like to ask the Minister to direct the health boards to adhere to the 1986 agreement and to insist that his directive is binding on them. Had the Minister adopted a planned and careful approach to the rationalisation of our health services, along the lines suggested by Deputy Desmond when he was Minister, we would not be in this position tonight. Indeed, had the Minister's party resisted the temptation, in the national interest, to make political hay at a time when Deputy Desmond was trying to introduce on a phased basis a rationalisation of the health services we would not be discussing this matter tonight. I do not think any Members on this side of the House are responsible.
I should like to avail of this opportunity to respond to the Minister's suggestion in the House recently that the overrun of £55 million took place during the term of office of the last Government. That overrun did take place during our term of office but it was done by health boards controlled by the Minister's party. The Minister has been on the road to Damascus; he changed one morning from being a shadow spokesperson on health to a Minister for Health and in the change he became totally convinced of the need for fiscal rectitude. I have put a suggestion to the Minister that would help resolve this dispute and I appeal to him to follow it up. I should like to appeal to both sides to come together and have direct talks. Is the Chair in a position to tell me how much time I have left?
The Deputy has until 8.03 p.m. but I gather that he is anxious to share his time with another Deputy.
I will be sharing my time. Next week I will have an opportunity, when considering the Estimate for the Department of Health, to make suggestions in regard to the health services. Nobody is anxious to spend time in hospital unless it is necessary and those who are ill should not have to worry about whether they will be cared for or if the medical support staff will be available to look after them. I have been alerted to the special problems that have arisen in some of our smaller hospitals and of the difficulties that have arisen in specialist units in our larger cities where consultants have to cover a number of hospitals. It is clear that next week people will die as a result of this strike, if it is not resolved. As a medical practitioner the Minister should be conscious of that.
I have found the IMO to be a responsible and reasonable group of people who do not wish to risk the lives of patients in hospitals or prolong the suffering of those in difficulty. However, the Minister has driven them into a position where they must show that they mean business.
I should like to ask the Minister to reverse his decision and set up the structures to deal directly with the IMO. Those in hospital and those awaiting admission are worried that the strike may escalate on Saturday and that they will not get treatment. I am satisfied that the strike can be stopped and that the issues can be resolved but for that to happen the Minister, and the Taoiseach, will have to be pragmatic and caring. We have all experienced relatives and friends having to go to hospital at short notice and are aware that many people are queueing at casualty departments awaiting admission. We are all aware that patients are being discharged early while others are at serious risk. We are all aware of the psychological pressure and the emotional trauma of fear and anxiety that people face when they are sick. I appeal to the Minister to help people avoid those conditions by meeting the IMO for realistic talks.
I should like to thank Deputy Allen for giving me some time to speak on this matter. Both he and I had put down a number of Private Notice questions today which have been subsumed in this debate.
I support Deputy Allen's plea to the Minister that he should enter into negotiations with the IMO to avert the general strike planned for Saturday with the resultant deterioration that would bring about in an already serious situation in the health services. In the little time available to me I will concentrate on what I perceive to be the reason for this strike. This is simply one flashpoint and even if the Minister resolves this one speedily, as I hope he will, there will be others unless the basic problem is resolved. It is quite clear that those in the front line of the medical services feel totally excluded from the decision making process in terms of rationalisation of the services. They believe that they are at least equal to any administrator and perhaps should be involved in the process of deciding how the medical services can be delivered in a more cost effective manner.
There is a level of hostility at present which has never existed before. In The Irish Medical News of 30 April Dr. Tim Collins described his view of what has been happening in the health services, that just because the country is in financial crisis it does not mean that all the executives of health boards and the Department of Health can send their brains out to lunch. He said it does not mean that we have to dismantle and destroy our health services, both primary and secondary and make cynical statements about transfer of resources to primary care. In The Medical Times of 10 April, Dr. Cyril Daly, a representative of general practitioners, referred to the Taoiseach and Minister MacSharry as two thoroughbreds — he was kind to them — and said they were like raging bulls in a china shop but that, unlike bulls in a china shop, they are not normally asked to pick up the pieces. It is quite clear that at present we are trying to pick up the pieces in the health services.
As I said, this strike is just a single flashpoint in the whole system which is in crisis and chaos and indeed in a state of shock. It is important that not only should this problem be resolved but that there should be an overall commitment to entering into the kind of discussions to which Deputy De Rossa referred, round table discussions with all the groups involved in the provision of the health services as to how a properly planned programme of rationalisation can take place.
On budget night there were gasps from this side of the House when the extent of the further cuts, over and above those already proposed in the January budget in the health area, were indicated. In the following debate it was suggested that we were simply playing politics and scare-mongering when we indicated the kind of problems which would arise. However, it was quite clear that the health services could not cope with cuts of the size implemented and maintain an adequate level of health service.
I ask the Minister and through him, the Taoiseach, whose presence is welcome, to think again very carefully about whether the health services are really the area in which they want to prove their serious intent in relation to the public finances. They should meet the IMO to resolve this dispute and then commit themselves to a rethink on the extent of cuts in the health services proposed for this year. They should get back to a rational plan which would have broad support in the House and outside it instead of implementing indiscriminate cuts which have led to this crisis. They should engage in a process of consultation because lack of it is causing anger and frustration especially when fundamental changes take place without consulting the front line personnel.
I want to say on behalf of the Progressive Democrats that if the junior hospital doctors' strike is allowed to escalate to an all out strike next Saturday we will have the most terrible strike ever seen where life and death will be the real issues. That must not be allowed to happen.
The Minister must ensure that the health services are properly run. He alone, with his Cabinet colleagues, carries the full and ultimate responsibility in this matter. We fully accept the financial constraints on the health budget which the Government have imposed but it is all the more vital, in the difficult climate which has resulted, that the Government govern and that the Minister administers.
The junior doctors' strike is but the latest and most dramatic symptom of the confusion and chaos which has resulted from the buck passing between the Minister and his Department on the one hand and the health boards and voluntary hospitals on the other. The Minister set the budget but hides behind the health boards and the voluntary hospitals from the unpopular fallout inevitably associated with cost cutting. The hospitals and the health boards then act unilaterally and crucial issues like the delivery of a proper health care service for those in need and other matters, like the junior doctors' contracts, fall foul of the black hole of confusion that has grown up between the Minister and the local health agencies.
I have always personally admired the Minister. He said recently that he cannot intervene while the strike is in progress. The Minister might take a leaf out of the book of one of his colleagues, the Minister for Labour who averted a major strike some weeks ago because of his actions. The Minister is new to office but he would be well advised to take his own counsel in this matter and to seek an immediate solution.
It is a firm belief of the Progressive Democrats that this strike of junior hospital doctors need never have happened, should not have been allowed to escalate and indeed could now be brought to an early conclusion were the Minister merely to direct that the February 1986 agreement, which was previously entered into, be now adhered to by hospital managements. Is that too much to ask the Minister to do? The terms of employment of junior hospital doctors have been for a long time a bone of contention. I recall pickets outside the Department of Health in the Custom House when the late Erskine Childers was Minister for Health in the early seventies. The principal complaint then was the inordinately long hours which junior hospital doctors were expected to work. In most of the intervening period this issue had not been satisfactorily resolved. On occasions the doctors withdrew their services, limited them and threatened to withdraw them but their overall concern for the welfare of patients resulted in their settling for less than a satisfactory conclusion to their problems on all those occasions. On the initiative of the Department of Health, the Local Government Staff Negotiations Board, the Federated Union of Employers and the IMO concluded an agreement on conditions of service for junior hospital doctors in February 1986 which was to be the basis for all contracts made between hospital managements and junior hospital doctors.
One of the clauses in that agreement says that an intern shall not normally be rostered to serve more than 70 hours in any one week. In another clause relating to house doctors the same provision applied, and in another clause applying to the post of registrar the same provision also applied. Yet we now have a situation condoned by the Minister as a result of indiscriminate cuts where these same junior hospital doctors are being asked to accept a reduction in numbers and to sign new contracts which, in many cases, will result in their having to work up to 120 hours per week. The dispute is about the number of hours that junior hospital doctors have been asked to work.
The 1986 agreement is being thrown out the window and we are back to the situation that had an earlier generation of doctors picketing the Custom House in the early seventies. The junior hospital doctors have another grievance about rates of pay for overtime work where they are paid less than the hourly rate. That is a genuine grievance but it is not the issue in this dispute. I have been informed on numerous occasions by representatives of junior hospital doctors that they recognise the need to reduce the overall cost of providing health care. They have indicated a willingness, if consulted, to identify and make suggestions on how greater cost efficiency can be achieved and substantial savings made — savings of as much as £35 million have been mentioned. Indeed the willingness to suggest areas for savings has been a consistent message from different groups employed in the health services if only adequate and full consultation had taken place.
I merely wish to make the point that, as I understand it, the junior hospital doctors are willing to shoulder their share of job cuts but not to the extent that hours worked would be in breach of the 1986 agreement. That is what it is all about. Having fought such a long battle to get rid of archaic working hours, who can blame them for protesting at the blatant breach of a solemn agreement that is now being attempted?
The public should know that a young doctor caring for them in a hospital ward, casualty department or operating theatre is expected to start his week at 8 a.m. on Monday, work and be available for work right through to 8.30 p.m. on Tuesday evening when he can return to his home. He must start work again at 8 a.m. on Wednesday, stay on duty overnight in the hospital before returning home. He is back again on Friday morning, on duty overnight in the hospital, working all day Saturday, all night on Saturday and Sunday, all day on Monday and cannot return home until Monday night.
This level of work for up to 120 hours a week, every week, continues for the duration of the six-month contract. These hours are worked jointly by two doctors who alternate the nights between them. This rota is known as the "one in two" and it is what caused all the difficulty before the agreement was reached in February 1986. That agreement provided for a "one in three", with the addition that a locum would be available to do duty if any of the three was not available, and resulted in an average of 80 hours per week. If the present cuts are applied many junior hospital doctors will be back to the old one in two rota. Some junior hospital doctors have been told they can get employment for six months but that they will not be paid. They have been offered free accommodation, free meals, free white coat, but no pay — I understand that offer was made in Holles Street.
At present we have 33 hospitals affected by the strike with 60 more likely to come out on Saturday — 93 of our major hospitals being affected. We know the calamitous, disastrous effects that will have on our health services and the danger to life. The IMO have made several conciliatory moves. In the statement issued yesterday they indicated that the solution to this strike would be the issuing of a directive from the Department of Health to all health boards and voluntary hospitals to implement in full the February 1986 agreement on conditions of service.
The strike would be very unfair and unreasonable on those hospitals that had reached agreement with their junior doctors, and that begs another question, namely, some hospitals and health boards are unable to honour the 1986 agreement on contracts. It is obvious that the grievances of the doctors are justified and understandable but in the context of the damage their strike will cause, literally putting life at risk, their action must not and should not go ahead nor is there any need for it to proceed. It is reasonable for the junior doctors to ask for the implementation of an agreement conceded to them. Would the hospitals and health boards take such unilateral action with regard to agreements and contracts with others, with powerful groups such as other trade unions, or professional groups? Would the Minister or the Government allow it to happen if major agreements were torn to shreds in the manner of this agreement?
It is quite clear that the buck stops with the Minister for Health because he is charged with ultimate responsibility to deliver a health service to the Irish people. He must now discharge that responsibility and not behave merely as a messenger boy for the Minister for Finance. I understand that this afternoon the management at Temple Street Children's Hospital called in 29 junior hospital doctors and informed them of the crisis looming in their casualty section if this strike is allowed to go ahead on Saturday. A very difficult situation will have been arrived at with the obvious danger to health, with each side digging in. With views hardening, the prospect of finding a suitable solution will become more and more difficult.
I have known the Minister a long time. I consider him to be very reasonable, a sensible and wise person. I appeal to his sense of justice. I appeal to him to ensure that this horrible event will not be allowed to happen. I appeal to him to give the directive to ensure that the conditions of employment under which these doctors understood they were employed be adhered to. That is a simple, reasonable request. In a dispute each side says things about the other and the longer the dispute goes on the more difficult it will be to resolve it. Between now and Saturday is the time when all efforts must be made to find a happy and sensible solution. It is not a major difficulty. It does not involve a massive amount of State funds. It does not mean the need for a Supplementary Estimate. All that is required is the application of common sense and in the past the Minister displayed plenty of that. I hope he will apply it to the present case.
I would like to begin by setting the current industrial action by the non-consultant hospital doctor members of the Irish Medical Organisation in context. In doing so I refer both to the existing level of action in certain health boards and hospitals and also the planned escalation of this action from Saturday next.
The context in which this action must be viewed is that of the overall state of the nation's finances. It is now accepted by the vast majority of the Members of this House that urgent remedial action was unavoidable if the financial integrity of the State was to be preserved. Acceptance of this fact dictated that the unsustainably high level of public expenditure which we have tolerated until recently could no longer be maintained.
It flows from this that the areas of most concentrated public expenditure, including health care, had to be forced to make significant economies. As the Minister responsible for the health services I recognised that it was not possible to implement these economies painlessly. My approach was, and is, to make every effort to ensure that the inevitable consequences of this very necessary policy should not bear heavily on those for whom the health services should care most: the sick, poor, the handicapped and the elderly. In this regard I refer to the statement of the Bishops' Conference recognising the need for reductions in health expenditure and stating the principles which should obtain in applying these reductions are principles to which I am fully committed. I have also sought to ensure that reductions in staffing are kept to a minimum and are distributed equitably across the whole range of health care personnel.
Unlike some Members of this House I cannot afford the luxury of, on the one hand, demanding that the economy be prudently managed while, at the same time, insisting that the various public services remain untouched.
I would remind Deputies Allen and Molloy that both their parties supported us here in the House three weeks ago that expenditure should not exceed £1,314 million, yet tonight they are suggesting we should be spending more than that.
I never said that.
The Deputy said there should be no cuts.
I never said it.
The tough decisions of resource allocation which we now face within the health services on a daily basis can only be made and sustained if they are seen to apply fairly to all of the various interest groups which constitute the health service workforce. I said earlier that equity demands that I not be seen to favour one group more than another. I might well add that logic also demands that approach.
I cannot reasonably expect that health care workers generally, and their representative bodies, will lend their support to policies which result in job losses, reductions in premium pay etc., while one group is seen to be protected from making its contribution to the general effort.
Could I now turn to arrangements for the provision of services during the proposed strike? I think it is necessary, first of all, to put the difficulties in context. Although the 1,821 non-consultant hospital doctors may be on strike, about 2,900 doctors will remain available to provide services to the public. There are 1,800 general practitioners providing a country-wide first line service. I would like to take this opportunity to appeal to the public to make the maximum use of their general practitioners and to seek service in hospitals only in cases of genuine emergency.
All the consultant staff in general and psychiatric hospitals will continue to be available. It will not, of course, be feasible or advisable to attempt to provide a full hospital service.
Those who are already in hospital will continue to receive all necessary care. Arrangements are being put in place for the provision of a consultant staffed accident and emergency service throughout the country. My Department will remain in touch with health boards and hospitals throughout the strike and the position will be kept under constant review.
I am happily in a position to give an assurance to this House and to the public that an adequate service will be available to meet accident and emergency cases which present during the course of the strike. I regret, of course, that routine hospital admissions will be delayed but should any emergency arise with any patient who is awaiting admission to hospital, it will be possible to deal with it quickly and effectively.
In cases of emergency, patients should make contact with their general practitioners, who will make all the necessary arrangements.
I want to emphasise the absolute importance of using the general practitioner service rather than resorting directly to hospitals. The public's co-operation in this matter will greatly facilitate the ability of hospitals to provide a good service to people who genuinely need the service that can be provided only in hospitals. Indeed, if there was no strike — and I speak as a general practitioner — this is how the service should always be utilised.
I recently met with representatives of the Irish Medical Organisation and discussed the proposed action by non-consultant hospital doctors. Following this meeting officials of my Department contacted each of the voluntary hospitals and health boards requesting that each agency invite local medical staff to participate in discussions. It was envisaged that these meetings would explain the implications of decisions taken affecting non-consultant hospital doctors and would also explore any possible ways of ameliorating such decisions through revised rostering arrangements, cutbacks in overtime etc.
It has been established that there was widespread consultation at local level and in many instances both in the health boards and the voluntary hospitals, this consultation proved successful. For example there were no problems for the non-consultant hospital doctors in Sligo and Letterkenny General Hospitals, in St. Conal's Mental Hospital and St. Columba's Hospital, Sligo, St. James's Hospital, Dublin, the Children's Hospital, Harcourt Street or in the Coombe.
Following local negotiations it was possible to reach agreement in the Mater Hospital, the Meath, the Adelaide, Portiuncula and the Mercy and South Infirmary in Cork. In fact almost two-thirds of public hospitals in the country are functioning without disruption at the moment.
At all times I have consistently urged that local discussion should continue, despite the fact that I am aware that in certain areas directions to local non-consultant hospital doctors have prevented agreement being reached or the discussions having any real purpose.
In a further effort to prevent the dispute officials of my Department met with representatives of the Irish Medical Organisation last Friday night.
This meeting lasted some five hours and a variety and combination of options were explored by both sides, unfortunately without positive outcome.
It is singularly disappointing that in areas previously unaffected by the dispute, or indeed where agreement had been reached, the escalation of the dispute will result in the hard work already completed being negated.
It can be seen that all efforts were made by local management and my officials to resolve this dispute. I have regretfully no option but to conclude that a small group of non-consultant hospital doctors were always intent on precipitating this action, regardless of the efforts of local management or my Department. Indeed, I understand that informal contacts are still continuing to see whether a basis can be found for negotiations aimed at resolving the dispute.
Over the last few weeks much has been made of the supposedly poor pay and conditions of non-consultant hospital doctors following the implementation of cutbacks in individual areas. I would now like to put these claims in context.
Over the past 20 years the conditions of non-consultant hospital doctors have improved significantly and they currently enjoy a very attractive remuneration package, as well as other valuable benefits. A non-consultant hospital doctor who obtains his medical degree and obtains a post of intern receives a basic salary of £9,965.
On completing his intern year, he moves to the house officer grade for a further period of 2 to 3 years. A third year house officer receives a basic salary of £13,052. When two years' experience has been acquired a house officer may compete for a registrar post. The basic salary for a registrar ranges from £15,083 at the minimum to £18,189 at the maximum.
In addition to basic salary, any non-consultant hospital doctor rostered for duty in excess of 40 hours per week receives additional remuneration. The rates of payment for these excess hours has been subject to repeated revision following examination by independent bodies, most recently in October 1986.
The package of remuneration for non-consultant hospital doctors also includes additional payments in respect of higher qualifications.
Fees from the Department of Social Welfare in respect of certificates issued to patients; fees in respect of providing lectures delivered to nurses; payment of a living out allowance where a hospital authority are not in a position to provide adequate accommodation and; payment of the cost of telephone installation and rental in situations where a non-consultant hospital doctor is living outside the hospital and is obliged to be on call.
A non-consultant hospital doctor is entitled to 32 calendar days' annual leave. In addition he is entitled to a further 8 working days per annum in lieu of the liability of being rostered for duty on public holiday.
A non-consultant hospital doctor is also entitled to any 14 calendar days with pay prior to an examination for higher degrees or diplomas including repeat examinations. Provisions regarding maternity leave, sick leave, compassionate leave are similar to those granted to permanent health service personnel. All of these conditions are available to doctors who, after all, are still in a training position.
The principal point being made by the media and medical representatives in the last few days concerns the excessive hours which doctors would be forced to work if the cutbacks proposed by local managements were to be implemented.
I do of course accept that in certain situations in certain specialties, non-consultant hospital doctors can have very onerous workloads and can be under considerable pressure at times. It should be pointed out however that many non-consultant hospital doctors do not encounter such pressure.
Some specialties may not have a very heavy workload outside normal hours. There can be therefore a wide variation in the level of activity of doctors not only between hospitals but also within different departments within the same hospital. When contacting the various agencies over the last number of days my officials have continually stressed that when considering their proposals, management should seek to ensure that as a matter of routine rostering, no doctor should be expected to work excessive hours. I myself have made that statement here in the Dáil in the last few days and have made it publicly on a number of occasions outside the Dáil.
As a result of a Labour Court hearing in 1986 to examine the rates of payment for hours worked in excess of a normal agreed working week, a steering group composed of representatives of all interested parties to conduct a review of the existing organisation of medical activity in hospitals was established.
This steering group has been operating since October 1986 and its report is due in the very near future. By their action at this stage, in advance of the issue of the report of this group, non-consultant hospital doctors are jeopardising an exercise which potentially is one of the most important initiatives taken for many years in the area of medical manpower.
While making every effort in the short term to contain expenditure levels within the allocations made to the various health agencies, I am also acutely aware of the need to arrive at long term reductions in health care costs, in the context of a rationalised service. Such a rationalised service will clearly require fewer beds than at present while maintaining the comprehensive nature of the service. This rationalisation progress provides a second avenue by which local arrangements can be arrived at to resolve this dispute.
I feel duty bound as a proud member of the medical profession to remind my non-consultant hospital doctor colleagues of the long and honourable tradition they now represent. It is a tradition that demands that no genuine emergency be ignored. The caring orientation of our profession has recently been highlighted again by the Medical Council in their reminder to doctors of their ethical obligation to ensure that continuing care and emergency treatment remain available to patients. I want to quote from a letter from the Medical Council which I received today and in which they stated:
The Council wishes to draw attention to the statement under the heading "Withdrawal of Services" in the recently adopted, "European Principles of Medical Ethics"
"When a doctor decides to participate in an organised collective withdrawal of services he is not released from his ethical responsibilities vis-á-vis his patients to whom he must guarantee emergency services and such care as is required by those currently being treated.”
I trust that the non-consultant hospital doctors will find it possible not to deviate from these standards should the industrial action proceed.
As I said in a statement yesterday the scale of the action proposed is out of all proportion to the matters remaining in contention. Given the impending report of the steering group to which I have already referred; the rationalisation process to be completed shortly; the agreements already reached locally; and the likelihood that with the goodwill of the IMO centrally, a number of other agreements could readily be concluded.
There is an overwhelming case for deferring the action decided upon. I would ask the non-consultant hospital doctors now, bearing in mind the noble tradition of service they have inherited, to consider the appeal I am now making, not only in the interests of the wellbeing of patients and their relatives, but also in the interests of the health services as a whole.
I am disturbed by the somewhat fatalistic note in the Minister's contribution where he said that we are faced with a very serious industrial dispute in the health services. There is one glimmer of hope where he indicates that informal contacts are continuing to see where a basis can be formed for negotiations aimed at resolving the dispute. I urge that every possible effort be made between now and Saturday — and if necessary the strike should be suspended by the non-consultant hospital doctors — to enable these discussions to progress.
There is a responsibility devolving on the Minister to end this dispute. I hope he has indicated firmly through the LGSMB and the FUE that his officers will continue to be available to endeavour to ensure that there is no escalation of the dispute. There are some 600 non-consultant hospital doctors in 33 hospitals involved in the dispute at present. It would be disastrous if there was an escalation of the dispute which would lead to some 1,500 staff withdrawing their services. I say to the non-consultant hospital doctors and to the people who are leading their negotiating team that there is nothing sacrosanct about Saturday nor is there anything sacrosanct or meritorious about going on strike and that they should suspend their action to enable the Minister and the LGSMB and the FUE to review the situation to see how this year's budget can be kept in place during the remainder of 1987 so that essential, emergency and basic hospital services in the acute area, in particular, be delivered to those who are in need.
No matter what role we play in society we will not forgive ourselves if a child, a mother, an elderly person, a person injured in an accident or a person requiring emergency treatment suffers unduly or terminally as a result of this dispute. Patients in need come first. I know from experience that it can be quite difficult, even with the best of facilities, to ensure that emergency rotas and arrangements are kept intact during a hospital dispute which involves a large number of people. I urge that notice be suspended so that discussions can take place. Even if the discussions are informal at present they can become formal and we would hope, lead to a resolution of the dispute.
The fundamental reason for this dispute is not that the 1986 agreement is being abrogated or messed around but because there is a basic lack of elementary resources in individual hospitals to enable the agreement to continue. This applies whether it is a reduction from £120 per week to £50 per week in the salary of student nurses, whether there are one or two extra rotas being introduced for non-consultant hospital doctors in some hospitals or whether people are simply being fired.
St. Vincent's Hospital which is in my constituency is a classic example of where this is happening. That hospital has 500 beds, 90 of which are being closed. St. Patrick's ward is being closed immediately. The budget for that hospital in 1986 was £22.5 million. Taking into account the 25th round that sum would normally have grown to around £23.1 million this year. However, the budget for this year is reduced to £20.51 million. That represents a cut of £2 million in the budget for St. Vincent's Hospital. In these circumstances it is easy to see why 90 beds have to be closed. There are 105 non-consultant doctors in that hospital. Two interns and SHOs will now have to be got rid of. The workload on the remainder of the staff will increase if the hospital maintains its present degree of activity. Inevitably, eight more staff will have to go in addition to the 12 already mentioned. Thirty student nurses have already gone since last week-end.
It is time this House began to appreciate that we cannot run a hospital like St. Vincent's or any other hospital if the budget is cut in that manner. Inevitably the non-consultant doctors will be crucified in that exercise and we cannot maintain the February 1986 agreement. The issue is the collapse in many acute hospitals of their basic budgets because of reductions of between 12 and 20 per cent. It is about time the people appreciated what that means in terms of the delivery of hospital care. I predicted that that would happen. Two days before Christmas I gave that memorandum to the last Government and I said that St. Vincent's Hospital would be cut by £2.4 million. In the event it was cut by £2.1 million. I resigned over it, because I knew what was going to happen. Ths Secretary of the Department of Health and the Assistant Secretary responsible for Finance knew what would happen and there is no point in blaming them.
The Minister is responsible, not officials.
The Minister should go back to the Cabinet and tell them that this dispute is an inevitable by-product of the reduction in the Health Vote and he should tell the Minister for Finance that he must get an extra £35 million for the remainder of this year in order to restore an ongoing delivery of acute hospital services. I do not care if the Minister for Finance next week in the Finance Bill raises health contributions from 1¼ per cent to 2 per cent. I will vote for it as will my party. We are prepared to pay for the continuation of the health services. Let us stop blaming CEOs, the health boards, the FUE, the boards of voluntary hospitals and so on. They can only do so much with the cloth that has been given to them. If the Minister puts another 2p on the packet of fags or 4p on a pint, I do not care, I want my health services. I do not want to have to bring my family down to Blackrock Private Clinic and pay £280 a day. I do not have the money anyway. I do not want to have to do that. I want to pay my contributions on a taxation basis so that when I need the services they will be there for myself and my family, and the doctors should not suffer in trying to deliver the service with an agreement which I was proud to enter into in February 1986 and which will inevitably be torn up.
It is not enough for Doctor Collins or anybody else to say that they accept the health cuts but that they want them applied fairly. They cannot be applied fairly to the NCHDs. There is no such thing as fairness when one gets into surgery of that nature. It cannot be done because the money is not there. St. Vincent's Hospital alone has to cut £1 million in pay and pensions this year and they have to take out £260,000 for the NCHDs. Inevitably they will be hammered, just as my niece, having done her training, got her walking papers from St. Vincent's Hospital and had to sign on in Victoria employment exchange last Friday. She has now gone home to Waterford and cannot even do her six months. She knows, and I know, that that is what health cuts mean. People will suffer and staff will suffer in the process.
That would have arisen under the Health Vote of the former Government. The new Minister went into the Cabinet and they took another £6 million off the budget and that is the result. Fine Gael, the Progressive Democrats and Fianna Fáil have supported the health cuts. They can have it. It is a rotten vote and it is short by about £35 million to £40 million. That money should be restored to the Health Vote. These are the options. I do not like them. It is outrageous that four NCHDs in Holles Street should be told that if they do their six months they will be given meals and a white coat, and probably a broken down stethoscope. When they said they would not accept it what did the hospital do? They said "we will give you £50 a month". That is not the way to run a health service. In St. Michael's Hospital in my own constituency, for instance, we should not bring back a one in two rota into a surgical ward and have an NCHD work 136 hours. I had my problems with the NCHDs. Some of them could not go on strike fast enough when I was there but we kept them at bay, we got agreement and we got negotiations.
I would make a point to the NCHDs. There is a report coming out on 24 June, a report which I commissioned in relation to the workload. It is a very complex area as almost every hospital is different. If the strike was deferred for a week or two that report would be available and the mayhem to be visited on the people by a total withdrawal of staff from all acute hospitals could be set aside.
The Deputy has two minutes left.
The fundamental question is the funding of our acute hospital system. If we take out the best part of £70 million from the acute hospital system, this is the result. It is not good enough for the NCHDs to say we accept the need for some cuts because inevitably they will suffer as nursing staff, as administrative staff and as every other staff in the hospital suffer. I would ask the Minister to abandon the singular viciousness of what has happened this year in the budget and go back to the Cabinet on Friday morning and say that he must get some additional resources to keep the acute hospitals going. The Minister for Finance, I am sure, will agree because in this case he misjudged the situation and his senior officials drastically misjudged the situation. They would not accept the information given by the Department of Health and they are paying a rotten price for it now. We cannot blame the Department of Health or the Minister for Health because he can only allocate the money he gets and he is being crucified in the process. That is no solution. I appeal to the NCHDs, in the national interest, to suspend their action. That is the minimum we can ask and in return the Minister should enter into negotiations with them to ensure that if there are reductions in the acute services they will be applied in an orderly and rational way. The Minister should endeavour to get funding from the Government for the health services for the remainder of 1986. Not a lot of money is required. He has saved a great deal in the past week alone and will save money even next week in terms of deferred admissions. That money could be a solution in a minor part of the major problem.
I must call another speaker.
The Irish people voted for what is supposed to happen next Saturday. Hopefully it will not happen. In a sense the people deserve what they are getting, but that kind of recrimination on my part is not productive. I hope the dispute will be suspended by the IMO. Some of them have been looking for a strike for three years. They should back off for a few weeks. Let them calm down and let the Minister make a final effort to resolve this. It is within his capacity as Minister for Health to make some reallocations in the acute hospital area and damage can be avoided and people will not suffer in that process.
I welcome the former Minister's appeal to the non-consultant hospital doctors to call off this dispute. However, the former Minister has taken no responsibility whatever for the overruns in the budget of 1986 in the Department of Health which were unauthorised by the Cabinet at the time and allowed to occur by Deputy Desmond.
That old, warped record is nearly as old as——
It is well to restate the facts. Over £36 million was allowed to be overspent in 1986 by the former Minister for Health possibly without the approval of the Cabinet. Nevertheless, the former Minister for Finance and the Taoiseach of the time must have been made aware of the situation by Department officials. We are reaping the reward of the former Minister's inability to control the situation.
(Interruptions.)
The former Minister felt it worth his while to remove Government memoranda from the Department and I am sure he took plenty of other information with him as well when he left the Department. He was aware he was going to resign, but, of course, resignation was the easy way out for him, for former Minister Deputy Kavanagh, former Minister Deputy Spring and former Minister Deputy Quinn. It was a stage-managed affair in an effort to secure as many votes as possible. I wanted to reply to the former Minister, Deputy Desmond, about the point he made about the budget.
For the record, I should indicate the very determined efforts made to resolve this proposed dispute. The Minister Deputy O'Hanlon met with representatives of the Irish Medical Organisation recently and discussed the proposed action by non-consultant hospital doctors. Following the meeting, the Minister asked his officials to contact the health boards and voluntary hospitals asking each of the agencies to hold discussions with medical staff, in particular local non-consultant hospital doctors' representatives explaining the implications of any decisions taken affecting non-consultant hospital doctors and asking them to participate in discussions which might ameliorate the effect of such decisions, for example, revised rostering arrangements and so on. There has been widespread consultation at local level and in many cases that consultation has proved successful. Where agreement has not been reached, both the Government and Minister have urged that such consultation should continue. I make that appeal again here this evening. In addition, officials of the Department of Health had detailed direct discussions with the IMO to try to resolve the dispute.
As a result of these efforts, agreement has been reached in many hospitals and agreement is very close in many others. I am aware that directions to local non-consultant hospital doctors' representatives have prevented agreement being reached in many places, without any breach of the 1986 agreement on conditions of service. Despite the considerable progress which has been made, the non-consultant hospital doctors have now taken the drastic step of escalating the dispute from Saturday next.
I consider it unreasonable that a section of the medical profession with its long tradition of caring service should in the light of the progress being made respond in this way. It is important in the case of all disputes, but particularly in the case of disputes in the health service, that staff should weigh in the balance the scale of the action proposed and the distress likely to be caused. I think the action proposed is totally unjustified in the circumstances of the issues remaining unresolved. It is my view, a reflection of a sense of grievance felt by some non-consultant hospital doctors rather than the reality of their circumstances and, unfortunately, they seem to have imposed their views on the majority.
There are impending developments which reduce further the justification for the action now being taken. First, there exists at present a specially formed steering group with equal representation from management and the IMO who are examining the existing organisation of medical activity in hospitals with particular reference to arrangements etc., for non-consultant hospital doctors. The work of the steering group has progressed satisfactorily and the IMO have expressed to the Minister their satisfaction on progress made to date. The report of the steering group will be available in a matter of weeks and it is potentially of major importance for non-consultant doctors and the hospital service generally.
The main reason for undertaking the exercise was to provide information which would enable the payments made to the doctors to be reassessed to encourage the most effective use of skilled medical manpower. While meeting non-consultant hospital doctors' objections to the present arrangements for out-of-hours work, it would also provide the basis for a possible restructuring of the out-of-hours remuneration package.
For the record, the steering group set itself the task of: gaining a full understanding of and describing how all medical activity in hospitals employing non-consultant hospital doctors is organised; gaining a full understanding of and presenting an accurate, representative account of the extent and components of such activity in terms which will be relevant and helpful to the determination of an acceptable method of payment; analysing and describing the present methods through which medical activity in hospitals is determined, monitored and controlled and presenting a full analysis of their findings and drawing such conclusion as they consider appropriate. As I have said, the report of the steering group is expected shortly. There is no reason, given goodwill on the part of the IMO, why preliminary discussions on issues arising from the report cannot be got under way quickly. I would be very concerned that the action now contemplated would jeopardise these discussions.
It might be useful for the House if at this point I gave some details of the remuneration package currently available to the doctors. The Minister has already outlined this situation. A house officer's basic salary for a 40-hour week rises from £11,335 to £16,411; a registrar's from £15,083 to £18,189. In addition, for hours in excess of 40 for which non-consultant hospital doctors are rostered hourly payments rising to £4.18 per hour are payable. It must be emphasised that while non-consultant hospital doctors may be rostered for such additional hours and are available they are not necessarily working. Let us compare that with the hours of employment of Deputies and Senators, but Deputies in particular. We work very long hours per week in a very difficult profession.
It is a rather inapt comparison.
Nevertheless, we have the long hours and we are on duty seven days a week as well, as Deputy Desmond knows. Non-consultant hospital doctors have perks.
Should we go on strike?
There is just a minute or two left in the debate. The Minister without interruption.
Non-consultant hospital doctors have perks which cannot be regarded as ungenerous. For example, they are entitled to 32 days leave per annum plus eight working days in lieu of the liability for being rostered for duty on public holidays. Payment while on leave is on the basis of ten notional hours per each day's annual leave or 70 hours per week of annual leave, that is 40 hours basic pay plus 30 hours at the appropriate rate for excess hours. In addition, they are entitled to study leave — 14 days with pay prior to certain examinations, accommodation or a substantial living-out allowance, allowances for higher qualifications and the cost of telephone installation and rental: in all a reasonable remuneration package by any standards.
The Government in their statement on Tuesday last urged that, where agreement had not been reached by non-consultant hospital doctors in local discussions, such discussions should continue because the necessary detailed information required to reach agreement is available locally and the financial implications, which differ from hospital to hospital, can be properly assessed by local managements only. The fact that agreement has already been reached in many areas by way of local discussions underlines this position.
It would be a sad commentary on a learned profession, with its long tradition of caring, that the non-consultant hospital doctors should embark on this action when negotiation is far from being exhausted. At the very least, their action should be deferred to await the outcome of further local discussions.
The Minister is contacting health boards and voluntary hospitals regarding the provision of emergency cover. I would expect that those doctors who have already carried the burden of emergency cover, despite difficulties, would continue to do so. Officers of the Department will be in touch with the Irish Medical Organisation about the level of emergency cover to be provided by those taking industrial action. I make this appeal to non-consultant hospital doctors — to call off their proposed action and not place the lives of innocent patients at risk. This appeal should be re-echoed by every Member of this House to the doctors at this stage: would they, for God's sake, call off their action because they will place the lives of innocent patients at risk?